[Possibilities of using results of head computed tomography in victims with traumatic brain injuries]. / Vozmozhnosti ispol'zovaniya rezul'tatov komp'yuternoi tomografii golovy u poterpevshikh s cherepno-mozgovoi travmoi.

The constant increase in the number of neurotraumas in the country leads to an increase in forensic examinations of a persons. In Russia, about 600 thousand people receive craniocerebral injuries annually, of which 50 thousand die, others are potentially will be in forensic examination during or after treatment. With an increase in the total number of such examinations, the number of erroneous conclusions is expected to increase. If it is impossible for the radiologist included in the commission to review the results of computed tomography of the head performed in the hospital, the experts are forced to use the data that are recorded in the medical documents. The present study revealed the percentage of erroneous interpretations in such descriptions, systematized typical errors, calculated the sensitivity, specificity and accuracy of computed tomography in craniocerebral injury.

[FIRES Syndrome in a Preschool Child]. / Sindrom FIRES u doshkol'nika.

Severe epileptic syndromes of childhood are an urgent problem for pediatric neurologists and neuroresuscitators. The article presents a clinical observation of FIRES syndrome in a pediatric patient, which is a form of severe drug-resistant epilepsy in children of preschool and school age, the development of which is caused by hyperthermia, probably associated with herpesvirus (human herpesvirus type 6) infection. The features of the progressive course and the difficulties of diagnostic search are reflected. An empirical approach to etiotropic therapy is described, since the disease manifested itself with respiratory manifestations and fever. The tactic of pathogenetic treatment is described, in which drugs of polyfunctional action, such as Cytoflavin, have a priority, many years of experience in the use of which allows the authors to recommend it as a starting intensive therapy.

[Distance teaching of forensic medicine at the department of medical university during the COVID-19 pandemic]. / Distantsionnoe prepodavanie sudebnoi meditsiny na kafedre meditsinskogo universiteta v period pandemii COVID-19.

The purpose of the work is to share the experience of distance teaching of forensic medicine. Teaching of forensic medicine throughout the history of the department of forensic medicine of the medical faculty of the Pirogov Russian National Research Medical University Research Medical University took place exclusively on the intramural basis. However, the COVID-19 pandemic has made its adjustments and teaching became remote. This situation required adoption of urgent measures to organize a high-quality and continuous process of student's teaching. The measures included preparation and formation of all necessary material equivalent to full-time classes in the electronic format; compilation and development of instructions and algorithms for students and teachers on the cycle and development of uncredited or missed classes in a remote format; creation of groups in instant messengers with students and a teacher; organization of online classes using conferencing applications; recording a full course of lectures (available in students' personal accounts); creation of the possibility of online testing of the level of initial and acquired knowledge of students in two languages (In Russian and English). The experience of conducting classes in remote mode is generally positive, the measures taken have brought training to a qualitatively new level.

[Modern concepts on the pathogenesis of neuroborreliosis]. / Sovremennye predstavleniya o patogeneze neiroborrelioza.

The analysis of publications on the websites PubMed, ClinicalKey, devoted to the pathogenesis of neuroborreliosis (NB), using keywords for search: «pathogenesis of neuroborreliosis¼, «neuroborreliosis in children¼, «pathogenesis of Lyme disease¼, as well as an analysis of the results of the published research results of the staff of the Research Institute of Pediatric Infections, St-Petersburg, Russia is presented. Syndromes of early and late NB are more often observed among the forms without migrating erythema, and their development can be caused by all representatives of the species B. burgdorferi s.l. (B.b.), but more often - B. garinii, since it most effectively suppresses the factors of innate and adaptive immune response, reducing interferon production, phagocytosis and complement synthesis. The cause of immunosuppression with the development of NB may be simultaneous infection with several genovids and borrelia species or pathogens of other infections transmitted by Ixodes ticks, for example, infection with B.b. and tick-borne encephalitis virus. The ability to move along peripheral nerves, the change of surface antigens of the VlsE protein, as well as the formation of atypical cysts and granular forms allows B.b. to affect different structures of the peripheral and central nervous system, avoid an immune response and persist for a long time, causing chronic neuroinfection. Both the B.b. themselves, capable of being outside and inside glial cells and neurons, and inflammatory reactions developing in response to their introduction and associated with the synthesis of cytokines and chemokines and mimicry, cause damage to the vascular endothelium, vasculitis and impaired blood supply to the brain, demyelination, autoimmune inflammation and degeneration, leading to the development of NB syndromes, the spectrum of which varies depending on the duration of neuroinfection. In the development of NB and its outcomes, the following are also important: early initiation of treatment, the effectiveness of antibacterial drugs, the use of immunotropic agents that optimize the patient's immune response to the fight against neuroinfection, as well as the timely use of pathogenetic drugs, such as Cytoflavin, which have a complex effect on the vascular endothelium.

[Magnetic resonance imaging in diagnosis of complications of kidney and ureteral injury in different periods of traumatic disease]. / Magnitno-rezonansnaya tomografiya v diagnostike oslozhnenii povrezhdenii pochek i mochetochnikov v razlichnye periody travmaticheskoi bolezni.

OBJECTIVE: To assess the possibility of magnetic resonance imaging in diagnosis of complications of kidney and ureteral injury in different periods of traumatic disease. MATERIAL AND METHODS: There were 139 patients with kidney and ureteral injuries between 2015 and 2019. We clarified the MR-signs of renal complications in different periods of traumatic disease. RESULTS: We analyzed the effectiveness of MRI in identification of renal complications compared to ultrasound, excretory urography, computed tomography, intraoperative and follow-up data. High diagnostic accuracy of MRI for early and late manifestations of traumatic disease was demonstrated.

International links between Streptococcus pneumoniae vaccine serotype 4 sequence type (ST) 801 in Northern European shipyard outbreaks of invasive pneumococcal disease.

BACKGROUND: Pneumococcal disease outbreaks of vaccine preventable serotype 4 sequence type (ST)801 in shipyards have been reported in several countries. We aimed to use genomics to establish any international links between them. METHODS: Sequence data from ST801-related outbreak isolates from Norway (n = 17), Finland (n = 11) and Northern Ireland (n = 2) were combined with invasive pneumococcal disease surveillance from the respective countries, and ST801-related genomes from an international collection (n = 41 of > 40,000), totalling 106 genomes. Raw data were mapped and recombination excluded before phylogenetic dating. RESULTS: Outbreak isolates were relatively diverse, with up to 100 SNPs (single nucleotide polymorphisms) and a common ancestor estimated around the year 2000. However, 19 Norwegian and Finnish isolates were nearly indistinguishable (0-2 SNPs) with the common ancestor dated around 2017. CONCLUSION: The total diversity of ST801 within the outbreaks could not be explained by recent transmission alone, suggesting that harsh environmental and associated living conditions reported in the shipyards may facilitate invasion of colonising pneumococci. However, near identical strains in the Norwegian and Finnish outbreaks does suggest that transmission between international shipyards also contributed to those outbreaks. This indicates the need for improved preventative measures in this working population including pneumococcal vaccination.

[SEVERE INFECTIOUS DISEASE AS A PREDICTOR OF CRITICAL ILLNESS ENCEPHALOPATHY IN CHILDREN (CLINICAL CASE)].

In childhood, infectious diseases, as a rule, are generalized in nature with the development of urgent or critical conditions that require the transfer of the child to mechanical ventilation. A child's stay on mechanical ventilation, on the one hand, is vital, on the other hand, it is a factor that threatens the development of acute encephalopathy, mechanical ventilation associated pneumonia, polyneuropathy and myopathy of critical conditions. According to the authors, the incidence of critical encephalopathy in patients with generalized infectious diseases who are on mechanical ventilation is 75%, and in the long-term (after 1 year) outcome in convalescents, the frequency of neurological deficit reaches 33%. In this regard, it is extremely important to timely diagnose and predict encephalopathy, including in children, as well as early adequate therapy with the inclusion of a complex action drug Cytoflavin, which has not only an antioxidant, antiplatelet effect, but also anti-inflammatory and remyelinating. The article presents a clinical case of critical state encephalopathy, which developed against the background of a severe infectious disease after artificial ventilation with effective timely use of Cytoflavin.

Photon Transport in a Bose-Hubbard Chain of Superconducting Artificial Atoms.

We demonstrate nonequilibrium steady-state photon transport through a chain of five coupled artificial atoms simulating the driven-dissipative Bose-Hubbard model. Using transmission spectroscopy, we show that the system retains many-particle coherence despite being coupled strongly to two open spaces. We find that cross-Kerr interaction between system states allows high-contrast spectroscopic visualization of the emergent energy bands. For vanishing disorder, we observe the transition of the system from the linear to nonlinear regime of photon blockade in excellent agreement with the input-output theory. Finally, we show how controllable disorder introduced to the system suppresses nonlocal photon transmission. We argue that proposed architecture may be applied to analog simulation of many-body Floquet dynamics with even larger arrays of artificial atoms paving an alternative way towards quantum supremacy.

[Foreign body in the esophagus as a reason to assess the medical aid quality during the forensic medical examination]. / Inorodnoe telo pishchevoda kak povod dlya ustanovleniya pravil'nosti okazaniya meditsinskoi pomoshchi pri proizvodstve sudebno-meditsinskoi ekspertizy.

THE AIM OF THE STUDY: Was to investigate in detail the case of a combination of esophageal injury and aortic aneurysm from the standpoint of the perspective of medical care. It was established that the circumstances of the improper provision of medical care in this case were the subjective nature in the form of insufficient and incorrect provision of it. It is shown that continuous training of doctors and mid-level medical workers within the continuing medical education is a gurantee of proper medical care.

[Thrombosis in patients with myeloproliferative neoplasms. Case report].

Thrombotic complications are the most significant factors determining the prognosis in myeloproliferative neoplasms. Markers for assessing the risk of thrombosis are the number of leukocytes, platelets, hemoglobin level, hematocrit, age, molecular status, history of thrombosis, obesity, arterial hypertension, hyperlipidemia, hereditary or acquired thrombophilia. The pathogenesis of thrombosis in patients with myeloproliferative neoplasms is complex and multifactorial. In most cases, the etiological factor remains unknown. Currently, antiplatelet and anticoagulant therapy is carried out on an individual basis. The algorithm for primary and secondary (after thrombosis) prevention requires development and testing. We present a clinical case of repeated arterial and venous thrombotic complications in a patient with primary myelofibrosis.

[The prognostic value of ASXL1 mutation in primary myelofibrosis. Literature review and clinical case description].

Primary myelofibrosis is a myeloproliferative neoplasm that occurs de novo, characterized by clonal proliferation of stem cells, abnormal expression of cytokines, bone marrow fibrosis, hepatosplenomegaly as a result of extramedullary hematopoiesis, symptoms of tumor intoxication, cachexemia, peripheral blood leukoerythroblastosis, leukemic progression and low survival. Primary myelofibrosis is a chronic incurable disease. The aims of therapy: preventing progression, increasing overall survival, improving quality of life. The choice of therapeutic tactics is limited. Allogenic hematopoietic stem cell transplantation is the only method that gives a chance for a cure. The role of mutations in a number of genes in the early identification of candidates for allogeneic hematopoietic stem cell transplantation is being actively studied. The article describes the clinical case of the detection ofASXL1gene mutations in a patient with prefibrous primary myelofibrosis. The diagnosis was established on the basis of WHO criteria 2016. The examination revealed a mutation ofASXL1. Interferon alfa therapy is carried out, against the background of which clinico-hematological remission has been achieved. Despite the identified mutation, the patient is not a candidate for allogeneic hematopoietic stem cell transplantation. Given the unfavorable prognostic value of theASXL1mutation, the patient is subject to active dynamic observation and aggressive therapeutic tactics when signs of disease progression appear.

[Adverse drug reactions of local anesthetics used in dentistry]. / Nezhelatel'nye reaktsii na mestnye anestetiki pri ikh primenenii v stomatologii.

The aim. Study the adverse drug reactions (ADR) that occur when using local anesthetics (LA) in patients living in the Republic of Crimea and registered during the period 2010-2018. MATERIAL AND METHODS: The objects of the study were 122 notification forms about LA ADR recorded in the regional base (Register) of spontaneous reports called ARCADe (Adverse Reactions in Crimea, Autonomic Database). In most cases, ADR was associated with the use of amide LA Lidocaine - 69 cases (56.55% of the total number of cases for LA ADR), less often, ADR was caused by combinations containing Articaine (34 cases, 27.87%). Rare cases of ADR were reported for Novocaine/Procaine (9 cases, 7.38%), Bupivacaine (8 cases, 6.56%) and Mepivacaine (2 cases, 1.64%). The main clinical manifestations of reactions were hypersensitivity-like reactions (38 cases), cardiac and vascular disorders (29 cases) and central nervous system disorders (19 cases). Lack of effectiveness of LA occurred in 13 cases (10.66%). RESULTS: A study of the outcome of ADR revealed a high incidence of life-threatening conditions associated with LA use - 31 cases (25.4%), which indicates the severity of the event and the need to cancel the suspected drug and prescribe additional medications for correction. The need for hospitalization or prolongation of hospitalization was necessary in 7 cases (5.8%), and temporary disability of patients was revealed in 5 cases (4.1%). Of particular interest are 2 cases (1.6%) of the development of a fatal outcome as a result of the suspected anaphylactic shock (1 case) and disorders of the central nervous system (convulsions, development of respiratory failure). CONCLUSION: The high frequency and severity of unwanted effects resulted from the use of LA requires healthcare professionals to make rational choices and strictly monitor patient safety.

[A multitrauma: diagnostic capabilities of computer tomography in forensic medical practice]. / Sochetannaia travma tela: diagnosticheskie vozmozhnosti komp'iuternoi tomografii v sudebno-meditsinskoi praktike.

For the last thirty years, many scientific publications have been devoted to diagnostic capabilities of postmortem computer tomography (CT). Nevertheless, up to the present day, the expediency of the substitution of a traditional postmortem dissection with a postmortem CT is still not proved. Foreign countries develop methods improving visualization in case of postmortem CT, study the correlation between the time of death and artefacts encountered in the further CT of cadavers. The authors have performed a comparative analysis of the results of intravitam X-ray examinations and data of postmortem dissections basing on the data of the professional literature and authors' own research. Diagnostic capabilities of CT in case of multitrauma have been determined.

[Clinical and some biochemical features of rhinosinusitis of different etiology]. / Klinicheskie i nekotorye biokhimicheskie osobennosti rinosinusitov razlichnoi étiologii.

Identified pathogens, and studied the features of the clinical picture, the level of antioxidant activity, the number of TBA-active products, cytokines, chaperones proteins and antibodies against them in the serum of patients with fungal, viral, bacterial rhinosinusitis (RS) were studied. Most RS of viral nature are caused by rhinoviruses, in turn, the causative agent of bacterial RS, most often acts as a polyflora (S. epidermidis, S. aureus, Pseudomonas aeruginosa). In the group of fungal RS prevailed A. fumigatus. It is noted that a more severe clinical picture in patients bacterial RS; it was manifested by a prolonged course, more pronounced nasal congestion, smell impairment and frequent relapses of the disease. High levels of LPO and a decrease in serum antioxidant activity were established for all studied infectious RS with a maximum imbalance in the LPO-AOP system in fungal forms; shift of the cytokine profile towards pro-inflammatory factors (IL-1b, IL-2, IL-8, IL-6) was registered in bacterial and viral RS and towards the values of anti-inflammatory IL-4 - in fungal RS. The increased amount of chaperone proteins was seen in bacterial RS; high concentration of antibodies against them was noted in fungal and viral RS.

[Magnetic resonance imaging for diagnosis of acute appendicitisin pregnant women in multi-field hospital]. / Vozmozhnosti magnitno-rezonansnoi tomografii v diagnostike ostrogo appenditsita u beremennykh v usloviiakh mnogoprofil'nogo statsionara.

OBJECTIVE: Tooptimize MRI protocol in pregnant women with suspected acute appendicitis. MATERIAL AND METHODS: There were 44pregnant women (gestation period 11 - 36 weeks)with suspected appendicitis. RESULTS: Fat-suppressed T2-weighted and diffusion-weighted imaging (DWI) was the most valuable to diagnose inflammation of appendix and surrounding tissues. Sensitivity, specificity and accuracy were 100, 90 and 97.8%. CONCLUSION: MRI was useful to assess appendix and differentiate appendicitis with biliary and urinary diseases.

[Efficacy of laboratory methods of diagnostic of purulent bacterial meningitis.]

According to the World Health Organization, every year about 1 million cases of purulent bacterial meningitis (PBM) are registered in the world, of which 200 thousand cases end in death. Bacterial meningitis is polyethiologic, which makes the task of determining the pathogen the main in the organization of epidemiological surveillance, treatment regimens, planning of preventive and anti-epidemic measures. The quality of laboratory diagnostics has a key influence on this. The true incidence of meningitis of different etiology can be altered at low-efficiency laboratory diagnostics. This work was carried out to assess the effectiveness of existing laboratory methods for the detection of PBM pathogens: Haemophilus influenzae, Streptococcus pneumoniae and Neisseria meningitidis; as a part of the programme on sentinel surveillance of invasive bacterial diseases (IBD) carried out by the WHO regional office for Europe in a number of countries in Europe (Ukraine, Belarus), Transcaucasia (Azerbaijan, Armenia, Georgia), Asia (Uzbekistan, Kyrgyzstan, Kazakhstan) in the period 2010-2017. 2893 samples of clinical material (CSF and blood) obtained from patients with the meningeal syndrome were studied by four diagnostic methods: cultural method, latex-agglutination test, immunochromatographic test (BinaxNOW), PCR (conventional and real-time), used to identify the following pathogens: Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae. When identifying the causative agents of BM, PCR more effective than culture method is 5 times in detecting N. meningitidis; 3 times in the detection of S. pneumoniae; 4 times the detection of H. influenzae b. Latex-agglutination test and immunochromatographic test allow to increase the identification of pathogens of BM for N. meningitidis - by 35.6%; S. pneumoniae - by 67%; H. influenzae b - by 19.2%, it is possible to set them in the field and at the epidpoint if necessary. When working with clinical material from patients diagnosed with GBM, it is advisable for bacteriological laboratories to complement the culture method of microbiological diagnosis of latex-agglutination test, immunochromatographic test or PCR.

[Possibilities for optimizing the pathogenetic therapy of purulent meningitis in children]. / Vozmozhnosti optimizatsii patogeneticheskoi terapii gnoinykh meningitov u detei.

AIM: To assess an effect of the combined use of Cytoflavin and Sulodexide on the course and outcomes of purulent meningitis in children. MATERIAL AND METHODS: Fifty children with purulent meningitis, aged from 5 to 17 years 11 month, were studied. Thirty patients of the treatment group (n=30; mean age 6,8 ± 2,2 years) received Cytoflavin (0,6 mcg/kg once a day) during 5 days with the following treatment with Sulodexide (250 LSU/day in children 5-12 years, 500 LSU/day in children above 12 years). Patients of the comparison group (n=20), aged 5,9±1,8 years, received standard antibacterial treatment. Duration and persistent of fever, cerebral, meningeal symptoms, the recovery period of CSF, the normalization of the number of desquamated epithelial cells (DEC), D-dimer were estimated. Outcomes of purulent meningitis were assessed using a working scale representing a modification of Rankin's, Fisher's, and Glasgow scales. RESULTS AND CONCLUSION: The combination of drugs reduces the duration of cerebral and meningeal symptoms, leads to the normalization of hematological parameters (the level of leukocytes, desquamous epithelial cells, D-dimer) and improves outcomes.

[The diagnostic potential of computed tomography for the purpose of forensic medical examination of a craniocerebral injury]. / Diagnosticheskie vozmozhnosti komp'iuternoi tomografii pri sudebno-meditsinskoi ékspertize cherepno-mozgovoi travmy.

The authors make use of the data borrowed from the special literature and the results of their original investigations to carry out the comparative analysis of the materials of the intravital X-ray studies and post-mortem examinations. Special attention is given to the possibilities available at the present time for making virtopsies in the cases of the craniocerebral injury.

[Deficit of Magnesium and States of Hypercoagulation: Intellectual Analysis of Data Obtained From a Sample of Patients Aged 18-50 years From Medical and Preventive Facilities in Russia].

The states characterized by pronounced hypercoagulable components (deep vein thrombosis, cardio- and cerebro-vascular pathologies) are caused by multiple pathophysiological factors, including insufficient supply of magnesium (Mg) and other micronutrients. AIM: to present results of analysis of the Institute of Microelements Data Base (IMDB) performed from point of view of interrelationships of Mg deficit and hypercoagulable states in adults treated in medico-preventive facilities of Central, Northwestern, Northern, and Siberian federal districts of Russia. METHODS: The analysis was realized as analysis of data obtained in a cross-sectional study. In the cohort of patients (n=1453) formed from the IMBD adequacy of Mg supply was assessed by magnesium levels in blood plasma (Mg BP) (0.69±0.15 mmol/L) and estimates of daily Mg consumption according to dietary diaries (Mg D) (185±90 mg/day). RESULTS: Mg supply was adequate (Mg BP >0.80 mmol/L, Mg D >300 mg/day) in not more than 6 % of patients. Presence of "Hypercoagulation" label in data base was associated with greater number of chronic diseases (2.3±2.1 and 0.83±0.8 with and without this label, respectively, р=0.0006) and elevated risk of the presence on 4 comorbid pathologies (odds ratio [OR] 18, 95 % confidence interval [CI] 10-25, р=0.0006). Mg deficit (Mg BP.

Cepeginterferon alfa-2b in the treatment of chronic myeloproliferative diseases.

AIM: A comparative evaluation of the effectiveness of different therapeutic strategies in patients with polycythemia vera (PV) and essential thrombocythemia (ET). MATERIALS AND METHODS: Patients with PV or ET, diagnosed according to the criteria WHO 2016 were included in the study. The primary endpoint - 6 months of therapy (clinical-hematological and molecular responses). The secondary endpoint - 12 months of therapy (clinico-hematologic, molecular, histological responses). Sixty three patients were included in the analysis: the first group consisted of 33 patients who received the therapy with ce-pegiterferone alpha-2b (ce-pegalpha-INF-α-2b), 10 of them received previous treatment; the second group - 23 patients btained hydroxycarbamide; the third group - 7 patients were treated with recombinant interferon alpha therapy (rINFα). In comparison groups, differences in age were revealed: patients receiving hydroxycarbamide therapy were older. Phlebotomy occurred in 36% of patients in the first group, 9% in the second group, and 14% in the third group. RESULTS: By the 6th month of therapy, 43% of the patients receiving the ce-pegalpha-INF-α-2b had complete clinical-hematologic response, 36% had partial clinical-hematologic remission and stabilization of the disease was established in 21% cases. No disease progression occured. By the 12th month of therapy, statistically significant differences in terms of efficacy between the different therapeutic groups (p = 0.2462, Fisher's exact test). In all three groups, the allelic load of JAK2V617F decreased: from 50 to 19%, from 22.3 to 15.8%, from 50 to 7.19%, respectively. The lower the allele load positively correlated with better response to therapy, which was observed in all analyzed groups. Hematologic adverse events (AEs) were more frequently observed in patients receiving ce-pegalpha-INF-α-2b therapy. Local reactions developed on 3-7 days of therapy as a hyperemic macula at the injection site. Both these reactions and hair loss did not influence on patient's condition. In the second group (patients with hydroxycarbamide therapy) there were changes in the skin and mucous membranes: dry skin, stomatitis, and in older patients new keratomas appeared. The flu-like syndrome was the most common adverse event associated with the therapy of ce-pegalpha-INF-α-2b, which fully relived during the first month of therapy. There was only one case with the flu-like syndrome we observed at the 11th month of therapy. As a rule, the biochemical blood test changes did not influence on patient's condition, were mostly associated with dietary violations, had a tendency to self-resolution and did not require medical interventions. Serious AEs were reported in one case - pulmonary embolism in a patient treated with rINFα. The reasons for the therapy discontinue in group 1: toxic hepatitis, intolerance, by the request of the patient, inadequate efficacy of therapy; in group 2: skin toxicity, in group 3: thromboses. CONCLUSION: Treatment of ce-pegalpha-INF-α-2b in patients with PV and ET is highly effective - the most patients pbtained clinical and hematological responses. There were no statistically significant differences in these parameters in comparison with hydroxycarbamide and rINFα. The use of the ce-pegalpha-INF-α-2b had an acceptable safety profile. The estimated therapeutic dose should be calculated according to body weight. To reduce the frequency of hematologic AE, titration of the drug dose is required.